In a recent study published in JAMA Network Open, researchers investigated whether lifestyle interventions such as Mediterranean diet abidance and mindfulness-based stress reduction (MBSR) during pregnancy could effectively improve pediatric neurodevelopment at two years of age.

Study: Effect of a Mediterranean Diet or Mindfulness-Based Stress Reduction During Pregnancy on Child Neurodevelopment. Image Credit: ElizavetaGalitckaia/Shutterstock.com

Background

Maternal lifestyle and maternal stress are known modifiable risk factors for fetal neurodevelopment. Studies have reported that unhealthy dietary habits, including increased consumption of fats, and obesity among mothers, can negatively impact neurodevelopment in their children. At the same time, elevated maternal stress levels alter fetal brain structural growth and worsen postnatal neurodevelopment.

The pathophysiological mechanisms underlying these relationships are unclear; however, the hypothalamus-pituitary-adrenal axis (HPA) is reportedly involved. Interventions promoting healthy dietary patterns and stress reduction may restore HPA functions and improve fetal neurodevelopment.

About the study

In the present study, researchers evaluated the impacts of stress reduction and dietary interventions among pregnant females on neurodevelopment in their children aged two years.

The study included the Improving Mothers for a Better Prenatal Care Trial Barcelona (IMPACT BCN) parallel-group randomized controlled trial (RCT) participants, who were enrolled between February 2017 and October 2019 and followed up until childbirth (until 1 March 2020).

The trial was carried out at an educational facility in Barcelona. In total, 1,221 singleton pregnancies (between gestational weeks 19 and 23) with an increased risk of small-for-gestational-age (SGA) newborn delivery were randomly divided into three groups in a 1:1:1 ratio: the dietary intervention group, the Mindfulness-Based Stress Reduction (MBSR) program group, and the regular care group.

The dietary intervention group participants were provided group- and individual-level educational classes and walnuts and extra virgin-type olive oil complimentary every month.

The MBSR group participants underwent an eight-week stress-lowering program tailored to pregnant individuals, and the regular care group received pregnancy care as per standard protocols.

The MBSR program comprised eight weeks of weekly group classes (20 to 25 females per group) of 2.5 hours, one full-day session, and everyday practice at home. The sessions comprised didactic presentations, 45.0-minute mindfulness meditation practices, body awareness, group discussions, and mindful yoga. 

The IMPACT study’s primary endpoint was the proportion of SGA newborns, and the secondary endpoint was adverse perinatal outcomes. The third edition of the Bayley Scales of Infant and Toddler Development Scale (Bayley-III) was used for postnatal evaluation.

All individuals visited the university hospital after completing the intervention (between gestational weeks 34 and 36), to fill out perinatal data-related questionnaires and provide urinary samples for analysis.

The present study outcomes were scores for the motor, language, cognitive, motor, adaptive behavior, and social-emotional Bayley-III domains, evaluated by two trained physiologists. The outcome measure was neurodevelopment at 2.0 years, based on Bayley-III scores.

The relationships between Bayley-III scores, biomarkers, and questionnaire information were also assessed. Linear regression models were used for data analysis between July and November 2022.

Mediterranean dietary evaluations were performed using food frequency questionnaires (FFQs). Stress reduction was assessed using the Perceived Stress Scale (PSS), the State-Trait Anxiety Inventory (STAI) questionnaires, the World Health Organization’s Five Well-being Index (WHO-5), and the Five Facet Mindfulness Questionnaire.

Maternal mindfulness was assessed using the Five Facet Mindfulness Questionnaire (FFMQ). In addition, maternal 24.0-hour urinary cortisol and cortisone levels were monitored among participants who did not consume corticosteroids.

Results

In total, 626 pediatric individuals [333 (53%) males and 293 (47%) females] participated in the study, among whom the mean age was 25 months. Baseline characteristics were identical among the intervention groups. High adherence was observed among 177 individuals (72%) in the dietary intervention group and 137 (66%) in the MBSR group.

In comparison to regular care group children, those from the dietary intervention group showed higher Bayley-III scores for the socioemotional (mean 109 versus 103) and cognitive (mean 124 versus 119) domains, whereas the MBSR group children showed higher socio-emotional domain scores (mean 108 versus 103), than regular care group children. Similar differences were observed after data adjustments for the mothers’ socioeconomic status and the fetuses’ genders.

Adaptive, motor, and language scores were comparable in the study groups. The IMPACT BCN trial showed a significant decrease in SGA rates (14% with SGA in the dietary intervention group and 16% in the MBSR group compared to 22% in the non-intervention group).

However, non-significant differences were observed in Bayley-III scorings between SGA and non-SGA newborns. The dietary intervention scores showed significantly positive relationships with the language and cognitive domains.

Increased docosahexaenoic acid intake significantly improved language scores, whereas higher trans-fat intake was inversely correlated with language and social-emotional domain scores.

Maternal stress and anxiety levels in the pregnancy period showed significantly negative relationships with domains of Bayley-III. Higher WHO-5 scores were related to higher Bayley-III scores for the language, social-emotional, and adaptive behaviour domains. The 24.0-hour urinary cortisol and cortisone levels were significantly and positively related to the language Bayley-III domain.

Based on the study findings, maternal lifestyle interventions such as MBSR and Mediterranean diets during pregnancy can significantly improve child neurodevelopmental outcomes at two years of age.

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